- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.06 / $16.09 / $135.52
| Facility | | $12.06 | $16.09 | $135.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $13.44 / $27.34
| Professional | | $12.06 | $13.44 | $27.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.55 / $51.76 / $58.45
| Facility | | $25.55 | $51.76 | $58.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.79 / $10.56 / $20.92
| Professional | | $6.79 | $10.56 | $20.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.29 / $15.93 / $40.03
| Facility | | $10.29 | $15.93 | $40.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $11.12 / $21.68
| Professional | | $9.48 | $11.12 | $21.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.06 / $13.14 / $29.48
| Facility | | $12.06 | $13.14 | $29.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $21.59 / $28.00
| Professional | | $16.89 | $21.59 | $28.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $10.28 / $20.56
| Professional | | $7.35 | $10.28 | $20.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $98.60 / $98.60
| Facility | | $55.00 | $98.60 | $98.60 |